Enhanced efficacy of eptifibatide administration in patients with acute coronary syndrome requiring in-hospital coronary artery bypass grafting

Background-Patients with a recent episode of non-ST-segment elevation acute coronary syndrome before CABG have higher rates of operative morbidity and mortality than patients with stable coronary syndromes. The efficacy of ad ministering eptifibatide to these patients undergoing in-hospital CABG is u nknown. Methods and Results-The Platelet Glycoprotein IIb-IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy (PURSUIT) trial randomized 10 948 patients to receive either eptifibatide or placebo. There were 1558 st udy participants who underwent in-hospital CABG: 692 received placebo, and 866 received eptifibatide. The main substudy analysis end point was death o r myocardial infarction (MI) rates at the 6-month follow-up. The 30-day dea th or MI rates were 30.8% and 26.1% for the placebo and eptifibatide groups , respectively (P=0.041). The benefit of egtifibatide administration persis ted through 6-months of follow-up (32.7% versus 27.6% for placebo versus ep tifibatide, respectively; P=0.029). There was a greater reduction in the 6- month death or MI rate for patients who received eptifibatide within 72 hou rs of CABG (33.6% versus 23.8%; P=0.002) compared with the >72-hour group ( 31.6% versus 32%; P=1.0). The incidence of major bleeding was 56.6% for pla cebo-treated patients versus 58.2% for eptifibatide-treated patients (P=0.7 ). Conclusions-Eptifibatide administration in patients undergoing in-hospital CABG with a recent episode of a non-ST-segment elevation acute coronary syn drome results in a significant reduction in death or MI that is evident at 7 days and persists through the 6-month follow-up without a significant inc rease in perioperative bleeding rates.